MEDICARE: JASON ALTER D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN22099	FL
2	122300000X	Dentist	D11722	OR
3	1223G0001X	General Practice Dentistry	D11722	OR

General Provider Information

NPI Number	:	1750734703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ALTER D.M.D

Provider Business Mailing Address
First Line	:	430 3RD AVE S APT 205
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4181
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6759 1ST AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-1307
Country	:	US
Telephone Number	:	305-321-1752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	01/12/2023

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